Best Practice Scenario

• Web-based EBRS at birthing facilities

• Validates NCHS edits at time of data entry

• If record passes all validations, jurisdiction allows auto registration

• EBRS automatically generates IJE natality file and loads in STEVE

• STEVE transmits IJE file to NCHS in real time

Hospital Completes Birth

Record

Passes all NCHS edits?

Submit Record toVR Jurisdiction

Via Web

Correct Errors andResubmit for

Validation

SystemAutomatically

PerformsNCHS Validations

YN LocalRegistrationRequired?

System Auto Registers

Record

Go To2.0

Y

N

PaternityAcknowledgement

Required?

N

LIVE BIRTH

Go To3.0

VR Database

Generate RoutineSubmissions to

NCHS using STEVEEND

1.0 Best Practice

Y

QA BeforeRegistration?

Go To4.0

Y

N

Potential Reporting Delays: Local Registration

• Often a paper process• Longer filing deadlines due to geographic

or staffing issues • Manual record delivery• Keyed into local systems• Electronic record sent to central office on

hold• Central office must match, log, stamp and

key in local registration info

Hospital Completes Birth

Record

Passes all NCHS edits?

Submit Record toVR Jurisdiction

Via Web

Correct Errors andResubmit for

Validation

SystemAutomatically

PerformsNCHS Validations

N

LIVE BIRTH

VR Database

END

2.0 Local Registration

Print and Send Paper Record toLocal Registrar

Y

Local Registrar Manually Logs,

Reviews and FilesRecord

Hold forX Days

Record ReceivedFrom Local Registrar?

N

Mail or Deliver Record to

VR JurisdictionEND

Match Records,Manually Stamp,

Log, Key Local FileNumber

Generate RoutineSubmissions to

NCHS

Register RecordY

Timeliness Metrics:

A. Number of days from date of birth to when paper record is received from local registrar (A1 to A2).

B. Number of days from when record is received from local registrar to when record is registered (B1 to B2).

C. Number of days from when record is registered to when it is submitted to NCHS (C1 to C2).

C2

C1

B2

B1

A2

A1

Potential Reporting Delays:Paternity Affidavits

• Delay registration pending PA from birth hospital • If not established in hospital, awaiting parental

paper work or court order• Jurisdiction can usually proceed to register

record without father’s information if paternity documents not received within specified time frame

• Subsequent inclusion of the father’s information on the birth certificate after registration must be by court order

Hospital Completes Birth

Record

Passes all NCHS edits?

Submit Record toVR Jurisdiction

Via Web

Correct Errors andResubmit for

Validation

SystemAutomatically

PerformsNCHS Validations

YN

Register Record

3.0 Paternity Affidavit

LIVE BIRTH

VR Database

Generate RoutineSubmissions to

NCHSEND

Mother MarriedTo Father?

YHospital Provides Paternity

Documents to Parents

Hospital Records

Husband’s Info as Father

Paternity AffidavitSigned inHospital?

Hospital Submits Record

with Father’s Info

YN

Hospital Submits Record without Father’s

Info

N

PaternityAffidavitNeeded?

Signed/notarized PaternityAffidavit

Received?

YHold forX Days

N

Y

Verify Father’s Info Correct andComplete

N

Timeliness Metrics:

D. Number of days from date of birth to when paternity affidavit is received (D1 to D2).

E. Number of days from when paternity affidavit is received to when record is registered (E1 to E2).

E2

E1

D2

D1

Potential Reporting Delays:Pre-registration Quality Assurance

• Jurisdiction does QA prior to registration

• Request corrections from birth hospital

• Wait until corrections received from hospital

• Key corrections into record

• Re-do QA steps

• Register and submit

Hospital Completes Birth

Record

Passes all NCHS edits?

Submit Record toVR Jurisdiction

Via Web

Correct Errors andResubmit for

Validation

SystemAutomatically

PerformsNCHS Validations

N

LIVE BIRTH

VR DatabaseEND

4.0 QA before Registration

Y

Hold forX Days

Generate RoutineSubmissions to

NCHS

Perform QA On Record

Record FailsQA?

Request HospitalCorrection of

Errors

Y

HospitalCorrectionsReceived?

N

Y

Register Record

N

Timeliness Metrics:

F. Number of days from when record is received until QA is performed (F1 to F2).

G. Number of days from when record fails edits until request submitted to hospital to correct errors (G1 to G2).

H. Number of days from when hospital is requested to correct errors until errors are corrected. (H1 to H2)

I. Number of days from when errors are corrected until record is registered (I1 to I2).

I2

H1

G2

G1

F2

F1

I1

H2 Update Record

With Corrections

Best Practice Recommendations To Improve Timeliness

• Eliminate local registration where possible• Allow local registrar access to central VR

database for online local registration• Don’t hold up processing of electronic record

pending receipt of paper record• Do not delay birth registration when paternity

documents not received • Do not delay birth registration to conduct QA;

perform QA after records have been submitted to NCHS; provide corrected records subsequently if needed

Take the Time to Improve

• Conduct analysis of your own business practices

• Check your system’s performance reports• Use the flow diagrams or make your own• Measure your timeliness performance• Identify areas for improvement and set tangible

targets• Ask NAPHSIS for help with business process

improvement